Back PainBack Pain: : GynecologicGynecologic Facts & MythsFacts & Myths

BYBY

Mohammad A. EmamMohammad A. EmamProf. OB& GYNProf. OB& GYN

Mansoura Faculty of MedcineMansoura Faculty of Medcine

Mansoura integrated fertility Mansoura integrated fertility center (MIFC) EGYPTcenter (MIFC) EGYPT

www.ivfmifc.comwww.ivfmifc.com

What is backacheWhat is backache ? ?

Is stiffness and/or pain in the back

RATIONALE &CONCEPTRATIONALE &CONCEPT

Although back pain (BaP) is a common complaint, but it is a forgotten topic in most Ob& Gyn text books.

BaP represents a dilemma for the gyaecologists ,as many myths, facts and fictions not resolved by evidence- based data.

Era of complementary and alternative medicine ( CAM ).

EpidemiologyEpidemiology Female > male. The second common

complaint after headache

30-90 % in pregnancy.

Epidemiology Epidemiology cont…

Rarely due to any serious disease.

Sometimes a clear cause but mostly no cause can be elicited.

Causes of BaP in Causes of BaP in WomenWomen

A. Obstetric (pregnancy associated BaP).

B. Gynecologic.

C. Others: Ligaments. Muscular. Bones and joints. Referred (renal, rectal). Psychological. Metabolic.

Gynaecologic CausesGynaecologic Causes Prolapse (uterine). RVF. Ch. Cervicitis. Tumours. Endometriosis. Pelvic congestain. PMTS. Ut. Contractrains (polyp). Menst. Molimia. Osteoporosis

Diagnosis (Milestones)Diagnosis (Milestones) BaP caused by a gynecologic lesion:

Always diffuse. Midline OR bilat. Sacral, lumbo sacral and never high than L4 (LBP).

BaP which can be pointed with a finger tip ± local tenderness

not due to intrapelvic lesion.

Role Of GynaecologistRole Of Gynaecologist

1.1. Determine cause:Determine cause:History – Exam – Invest.

2.2. If no cause:If no cause: Reassurance. Correction of posture. Exercises. Simple drugs. Complementay &Alternative medicine.

Psychological.Psychological.

3.Consultation 3.Consultation (Referral if (Referral if serious serious problem problem is suspected).is suspected).

Correction Of PostureCorrection Of Posture

Advices:Advices:Stand up straight (smart).

Drop your shoulders and relax your knees when standing.

Correction Of PostureCorrection Of Posturecont..cont..

Sit well back into your chair, legs slightly apart with both feet flat on the ground.

Correction Of PostureCorrection Of Posturecont..cont..

In front of a computer screen:

Sit up straight

Keep your feet slightly raised off the floor on a footstool or other low object.

Correction Of PostureCorrection Of Posturecont..cont..

Always bend from your knees and lift objects and children from a crouching position to minimize the stress on your back.

Correction Of PostureCorrection Of Posturecont..cont..

Maintain your weight within the given parameters of weight gain.

Avoid standing for long periods of time.

SPINAL EXERCISESSPINAL EXERCISES

EXERCISESEXERCISES

. Simple exercises (curative).

.Activity not bed rest.

1. WAIST ROTATION1. WAIST ROTATION

2. HIP ROTATION2. HIP ROTATION

3. SPINAL STRETCH-3. SPINAL STRETCH-SIDE TO SIDE SIDE TO SIDE

4. SPINAL STRETCH-4. SPINAL STRETCH-FORWARD AND BACK FORWARD AND BACK

5. TORSO-TWIST5. TORSO-TWIST

6. PELVIC ROCK6. PELVIC ROCK

Alternative & Complementary Alternative & Complementary MedicineMedicine(CAM)(CAM)

Acupuncture and acupressure. Herbs (wheat oil……). Aromatherapy (essential oils added

to bath water). Massage and manual therapies

(Chiropractic care).

Alternative & Complementary Alternative & Complementary Medicine Medicine cont….

Hypnosis, music therapy, yoga as well as breathing exercises.

TENS & PENS.Cupping.

Praying.

Acupuncture & Acupuncture & BaPBaP

In early pregnancy is not advised because can

promote abortion

TENS & PENSTENS & PENS TENS: transcutaneous

electric N. stim. PENS:PENS: percutaneous

electric N. stim.

PENS is more effective than TENS because it combines advantages of TENS + elect. Acupuncture.

Cupping (baguanfa)Cupping (baguanfa)Cupping therapies often follow the point

selection pattern that is used for standard acupuncture therapy.

ChiropracticChiropractic "Chiropractic “comes from

the Greek word Chiropraktikos, meaning "effective treatment by hand”

"Science based on the theory that health and disease are life processes related to the function of the nervous system.

Gynecological Role Gynecological Role cont….cont….

Referral to:Physiotherapist.

Osteopath.

when serious problem is suspected

Back pain with possible Back pain with possible serious features serious features (Royal c of radiologists (Royal c of radiologists

guidelines)guidelines)

• Onset < 20, >55 yrs.• Sphincter or gait disturbance.• Saddle anaesthesia.• Severe or progressive motor loss.• Widespread neurological deficit.• Previous cancer.• Weight loss.• Steroids.• Structural deformity.

PsychologicalPsychological In majority No gross lesion. Patient is handed from physician to Gynecolog. to orthopedic to surgeon. Anxiety neurosis

sequalae.

FACTS OR FICTIONS;;FACTS OR FICTIONS;;Cervical erosion (ectopy) never causes back pain. Vaginal prolapse never cause backache.Uterine prolapse and RVF rarely cause dragging pain on uterosacral and cardinal ligaments.

Myths & Back Pain.Myths & Back Pain.

FALSE

FALSE

FALSE

FALSE

Lifting heavy objects causes back pain.

Bed rest is the best way to cure a bad back.

X-rays, cat scans and MRI can always identify the cause of back pain.

Most back pain will eventually need surgery.

OB& GYN, Mansoura Faculty of Medicine

Mansoura Integrated Fertility Center (MIFC) EGYPT

Telfax 0020502319922 & 0020502312299

Email. mae335@hotmail.com

www.ivfmifc.com